Shared Cultural Values Influence Mental Health Help-Seeking Behaviors in Asian and Latinx College Students
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Journal of Racial and Ethnic Health Disparities https://doi.org/10.1007/s40615-021-01073-w Shared Cultural Values Influence Mental Health Help-Seeking Behaviors in Asian and Latinx College Students E. Zhou 1 & Y. Kyeong 1 & C. S. Cheung 1 & K. J. Michalska 1 Received: 11 April 2021 / Revised: 22 May 2021 / Accepted: 24 May 2021 # The Author(s) 2021 Abstract The current study sought to understand the influence of cultural values on mental health attitudes and help-seeking behaviors in college students of diverse ethnic backgrounds. Asian and Latinx college students (N = 159) completed an online survey in which they reported on their adherence to cultural values as measured by ethnicity-specific cultural values and general attitudes towards mental health. Factor analysis revealed two common factors of cultural values irrespective of ethnicity: Interdependent Orientation (IO) and Cultural Obligation (CO). Regardless of ethnicity, the more students endorsed IO values, the less likely they were to perceive a need for mental health treatment. IO value adherence was also predictive of more negative attitudes towards mental health. CO values were not predictive of perceived need or help-seeking behaviors. Findings highlight the importance of understanding shared cultural values across ethnic-racial groups and considering how the multidimensionality of culture may help explain shared mental health behaviors crossing lines of ethnic group membership. Keywords Culture . Values . Help-seeking . Mental health attitudes . College students National rates of student mental health diagnoses and service this study examined whether family- and group-oriented di- utilization are increasing on college campuses across the USA mensions of cultural values that are shared among Asian and , yet glaring racial-ethnic disparities exist in treatment- Latinx college students are associated with perceived need for seeking behavior and receipt of psychological services . mental health treatment and mental health help-seeking, above Despite higher rates of psychological distress reported by demographic characteristics. A focus on shared cultural values Asian and Latinx students in particular [2, 3], these students can help mental health service providers understand barriers to access campus mental health care services at lower rates than help-seeking more completely without assigning blame to any their non-Latinx White peers [4, 5]. Of course, ethnic group specific ethnicity or culture. membership alone does not determine whether a student will seek mental health services. Other underlying factors need to be examined to understand how members of these groups Familism and Mental Health Behaviors approach available campus resources. We focus here on the role of cultural values pertinent to these ethnic groups on Individuals from Latinx  and Asian  cultures value stude nts’ mental he alth help-se eking b ehav io rs, familism, or the duty to assist, support, and respect one’s fam- complementing the extensive work on external barriers to ily. Research conducted separately in both groups has seeking treatment including language or financial resources established associations between high levels of familism and [6–9]. Though existing work has drawn connections between improved well-being via supportive family ties [14, 15]. cultural values and mental health attitudes among both Asian However, because family is viewed as an extension of the self and Latinx groups, the present work furthers the literature by in both cultures and the needs of the family are valued above examining shared values across groups [10, 11]. Specifically, the needs of the individual [16, 17], this can also imply that if an individual is experiencing psychological distress, then shame or stigma faced by that individual may also be experi- * K. J. Michalska firstname.lastname@example.org enced by the family. In line with this notion, acknowledging mental health problems is sometimes perceived as a failure 1 Department of Psychology, University of California Riverside, 900 shared by the family and extended kinship group in these University Ave. Riverside, California, CA 92521, USA cultures [18, 19]. Familism therefore may foreshadow
J. Racial and Ethnic Health Disparities unwillingness to seek professional treatment for mental illness those of European heritage in their appraisals of negative emo- [20, 21]. Familism in Latinx households has also been asso- tions, deeming them more undesirable and inappropriate to ciated with increased informal and religious avenues of help- experience and express . Stigma and shame, in conjunc- seeking for mental health care but not specialty mental health tion with viewing the family as an extension of the self, may service use . Ultimately, even though familism can be lead to resistance towards mental health treatment-seeking, as protective for mental health of youth from Asian and Latinx acknowledging a need for mental health treatment may reflect backgrounds, it may diminish some forms of mental health poorly on the individual and their family. Both Asian and help-seeking behaviors in these youth. Of note, previous work Latinx groups value the avoidance of shame [33, 34], and has observed gender differences in the associations between seeking treatment for mental health issues may be perceived familism and mental health outcomes among individuals of as particularly shameful. To avoid bringing shame to them- Asian and Latinx backgrounds, with women reporting poorer selves and their families, Asian and Latinx college students psychological health than men, despite greater levels of fam- may therefore shy away from initiating mental health treat- ilism and support . A study by Sanchez and Atkinson ment [35, 36]. One particularly alarming example of the ad- similarly finds that though strong Mexican-American cultural verse effects of stigma was documented among a sample of commitment was related to lesser willingness towards self- suicidal Latina adolescents, who viewed suicide as a viable disclosure in counseling overall, females were more willing solution to alleviate undue burdens of shame on their families to use counseling services than males . In another study . with Asian college students, Gim, Atkinson, and colleagues Studies that have directly evaluated links between socio- also observed a relationship between willingness to seek cultural values and mental health help-seeking stigma have counseling and both gender and acculturation . yielded mixed findings. Even though several such studies find However, though the gender difference was consistent such positive associations between Asian cultural values and stig- that women were more willing to seek counseling than men, ma, not all indicate that stigma is directly relevant to help- the relationship with acculturation was not, where by those seeking behavior [38, 39]. For example, Kim & Zane (2016) individuals who reported lower levels of acculturation were found that even though Asian American students perceived more open to professional help-seeking than those who report- greater barriers to help-seeking than non-Latinx White stu- ed higher levels of acculturation. The finding that less accul- dents, both groups showed an inverse relationship between turated Asian students were more willing to see a counselor stigma and help-seeking intentions . Likewise, in the lit- directly contradicted a previous study from Atkinson and erature on Latinx cultural values and stigma, adults report that Gim, which found that in a sample of Asian students, those stigma resulting from cultural expectations discourages them most acculturated held the most positive attitudes towards from admitting need for mental health help and adhering to a mental health services . Given these mixed findings, it is treatment plan, though less is known about its relationship to important to consider how cultural values and gender might seeking psychological services in college students . Some independently and interactively predict mental health behav- researchers find a stronger relationship with Latinx cultural iors across different groups in the college environment. To our values and stigma in older adults and a weaker one in college knowledge, no study has examined this question among Asian students, but it is yet unclear how this relationship might in- and Latinx college students. fluence mental health help-seeking [41, 42]. Collectively, these findings highlight both the complex role of cultural values in mental health contexts and the need for additional Mental Health Attitudes as Barriers to Mental research in culturally diverse settings. Health Help-Seeking Perceptions of Mental Illness Mental Health Stigma Beyond stigma, diminished rates of help-seeking in both One prominent psychological barrier to mental health help- Asian and Latinx college students may also stem from differ- seeking is mental health stigma, which manifests primarily ing perceptions of what constitutes a mental illness warranting in social and self-stigma, or negative public attitudes towards professional treatment. Both ethnic groups experience soma- mental illness and the internalization of these public percep- tization, reporting physical ailments in lieu of mental illness tions [26, 27]. Asian and Latinx students generally report [43, 44]. The tendency towards somatization may inadvertent- greater stigma about mental illness and mental health help- ly stem from stigma, in that it is more culturally acceptable to seeking behaviors compared with non-Latinx White students experience and seek treatment for physical ailments over men- [28, 29], which may in part be due to mental illness being tal ones . In fact, when somatic symptoms emerge, Asian considered an admission of emotional weakness [30, 31]. and Latinx individuals often seek out help from medical doc- Students of both Asian and Latinx heritage also differ from tors or alternative healers instead of psychological
J. Racial and Ethnic Health Disparities professionals for treatment [46–49], potentially leading to Asian or Latinx in 2019, respectively. All participants were greater rates of misdiagnosis . Additionally, those Asian recruited from the psychology department participant pool. and Latinx individuals who seek professional psychological Consent was obtained from all participants via electronic ac- treatment often present with more severe symptoms and tend knowledgment. Students were awarded course credit for par- to experience problems for a prolonged period of time prior to ticipation. Study approval was obtained from the university treatment, suggesting that the threshold for seeking mental Institutional Review Board. health services is higher for them [51–53]. Based on the men- tal health attitudes largely shared by Asian and Latinx college Measures students, they may be similarly deterred from making initial contact with on-campus mental health service providers. Yet, Cultural Values scant research has examined the shared cultural values that may influence mental health utilization behaviors across Asian Values Scale - Revised (AVS-R) The Asian Values Scale- ethnic-racial groups. Revised (AVS-R)  is a 25-item measure assessing en- dorsement of values associated with the Asian culture short- ened from the original 36-item measure . Participants in- The Present Study dicated the extent to which each statement applied to them (1 = strongly disagree; 4 = strongly agree), with higher scores Mental health treatment-seeking behaviors of Asian and indicating greater adherence to Asian cultural values. Latinx students have largely been examined within-group, Example items include “One should consider the needs of even though different studies find that similar cultural values others before considering one’s own needs” and “One should influence help-seeking behaviors in both Asian and Latinx not deviate from familial and social norms.” The scale has youth [6, 35]. Despite significant heterogeneity across and demonstrated strong reliability and validity in past research within cultures, we contend that some shared cultural values in university student samples , and Cronbach’s alpha in may lead to less utilization of campus mental health services this sample was .81. by Asian and Latinx students. Importantly, we do not put forth that Western mental health services are the only intervention Latino Values Scale (LVS) Participants also completed the 35- of choice for all students. However, given that available treat- item Latino Values Scale (LVS)  measuring endorsement ments in university settings in the USA are traditional Western of values associated with the Latinx culture. Participants indi- psychological treatment services, it is important to more com- cated the extent to which each statement applied to them (1 = prehensively understand students’ engagement with such pro- strongly disagree; 4 = strongly agree), with higher scores in- grams. The present study therefore aimed to examine shared dicating greater adherence to Latinx cultural values. Example relationships between cultural values, mental health attitudes, items include “One’s family is the main source of one’s iden- and mental health behaviors (perceived mental health tity” and “One must not offend others.” The measure yields a treatment need and help-seeking) in Asian and Latinx college total score (LVS - Total) and two subscale scores (LVS – students. Specifically, we tested (a) the extent to which cul- “Cultural Pride” and LVS – “Familismo”). The scale has dem- tural values endorsed by Asian and Latinx college students onstrated strong reliability and validity in past research in were shared, and how cultural values predicted (b) attitudes university student populations . We assessed adherence toward mental health, and (c) perception of mental health to Latinx values via the LVS - Total, for which the treatment need and help-seeking behaviors, above ethnicity Cronbach’s alpha in this sample was .89. alone. Attitudes Towards Mental Health Method Attitudes Towards Mental Illness (AMI) Mental health attitudes were assessed using 47 items adopted from two scales: Participants Community Attitudes Toward Mental Illness (CAMI)  and Reported and Intended Behaviour Scale (RIBS) . One hundred fifty-nine undergraduate college students (61% The CAMI is a 40-item measure that assesses prejudice female, 58.5% Asian, 41.5% Latinx, 55.3% first-year stu- towards and exclusion of the mentally ill and tolerance/ dents) from a public university in Southern California com- support for community care. Example items include, “One pleted a six-section online survey hosted on Qualtrics. The of the main causes of mental illness is a lack of self- sample was representative of the demographic majority of discipline and willpower” and “Mental illness is an illness like the university and California broadly , with about 75.3% any other.” Following prior recommendations (UK of students and 54% of California residents identifying as Department of Health Attitudes to Mental Illness
J. Racial and Ethnic Health Disparities Questionnaire) , we retained 26 of the original 40 items membership, all regressions controlled for ethnicity. and added one item on employment attitudes. To facilitate Participant gender was also included as a covariate to account interpretation, negative items were reverse-coded, such that for potential gendered cultural expectations, particularly overall scores indicated positive attitudes towards mental ill- pertaining to familism. In logistic regression models examin- ness. Cronbach’s alpha for the CAMI in this sample was .86. ing mental health behaviors, mental health attitudes were co- The RIBS is an 8-item instrument that measures both re- varied to isolate the unique effects of cultural values on mental ported engagement (e.g., “Are you currently living with, or health behaviors. have you ever lived with, someone with a mental health prob- lem?”) and intended engagement (e.g., “In the future, I would be willing to live with someone with a mental health prob- Results lem”) with individuals with mental health problems. To mea- sure students’ mental health attitudes, four items specifically Descriptive statistics and zero-order correlations among all assessing intended engagement were used. Cronbach’s alpha study variables are presented in Table 1. Overall, even though for the RIBS in this sample was .88. Asian and Latinx values were correlated, both Asian and Both the CAMI and the RIBS scales were scored based on Latinx students endorsed values in the Latinx values scale agreement with correct or non-stigmatizing statements on a 5- (M = 2.50, SD = 0.32) to a greater extent than those in the point Likert scale (1 = strongly disagree; 5 = strongly agree). Asian values scale (M = 2.35, SD = 0.31), t(158) = −8.61, p < Because of substantial correlation between the two scales (r = 0.001. An independent-samples t-test revealed that Asian stu- 0.65, p < 0.001), a composite score was used. Low scores on dents endorsed Asian values significantly more (M = 2.43, SD the AMI composite score correspond to negative attitudes, and = 0.27) than did Latinx students (M = 2.24, SD = 0.33), t(157) high scores correspond to positive attitudes. Cronbach’s alpha = 3.91, p < 0.001; there was no significant difference between for the composite score in our sample was .89. groups in endorsement of Latinx values. Perceived Mental Health Service Need and Help-Seeking Analysis One: Common Factor Structure among Asian Behavior Participants also responded to two multiple-choice and Latinx Value Scale Items questions about their own mental health needs and help- seeking behavior. First, they responded either “Yes” or “No” We first conducted an exploratory factor analysis, combining to the question, “Do you feel you need mental health help?” all items within both the AVS-R and the LVS into one model Only those who responded affirmatively (n = 33) were then to examine if latent variables were driving students’ response asked to respond “Yes” or “No” to “Are you seeking patterns to both scales. To this end, we tested whether items treatment?” loaded onto similar factors across the two groups from the pool of the 25 AVS-R items and 35 LVS items (Table S1). Data Analytic Plan Our analysis revealed two underlying factors, which we la- beled Interdependent Orientation (IO, 7 items) and Cultural The aims of this research were to determine whether some Obligation (CO, 7 items). Items in the IO factor centered around cultural values are shared among Asian and Latinx college the importance of one’s family and in-group, whereas items in the students and whether the degree of adherence to these values CO factor focused on the importance of actively participating in predicts students’ attitudes to mental health and their per- and preserving one’s culture. Each of the factors was internally ceived treatment need. To address the first aim, we conducted consistent, with a Cronbach’s alpha of .77 for IO and .83 for CO. an exploratory factor analysis of all items across Asian and Latino value scales (AVS-R and LVS respectively, see Table S1 for details), without an a priori hypothesis Table 1 Descriptive statistics and zero-order correlations for key study variables regarding the number of resultant factors. To address the sec- ond aim, we performed a series of linear regression analyses to Variable M SD 1 2 3 test whether AVS-R and LVS predicted students’ attitudes to mental health. We then repeated these analyses, using the 1. LVS 2.50 0.32 - 0.75*** −0.29*** factors that emerged from our factor analysis as predictors of 2. AVS-R 2.35 0.31 - −0.49*** attitudes to mental health. To further shed light on the associ- 3. AMI 118.37 14.62 - ation between shared cultural values and students’ help- Scaled LVS and scaled AVS-R scores have a possible range from 1 to 4; seeking behaviors, we conducted hierarchical logistic regres- AMI scores from 30 to 150 sions to test whether shared cultural values predicted students’ LVS Latino Values Scale, AVS-R Asian Values Scale-Revised, AMI perceived treatment need and help-seeking behaviors. Given Attitudes to Mental Illness our focus on cultural values above and beyond ethnic group ***p < 0.001
J. Racial and Ethnic Health Disparities The two factors were positively correlated (r = 0.35, p < 0.001) and their endorsement of cultural values predicted their per- within the whole group and within each ethnic group (Asian: r = ceived treatment need and their help-seeking behaviors. First, 0.39, p < 0.001, Latinx: r = 0.31, p = 0.01). Independent-samples t- we tested whether students’ mental health attitudes (assessed tests revealed no significant difference in mean scores of IO be- via the AMI) and their endorsement of Asian values (assessed tween participant groups (p = 0.73) and significantly greater mean via the AVS-R) predicted the likelihood that they perceived a scores on CO for Asian participants (M = 2.73, SD = 0.46) than need for treatment or the likelihood of their mental health Latinx (M = 2.58, SD = 0.51) participants, t(157) = 2.01, p < 0.05. help-seeking behaviors. Results are shown in Table S6. After controlling for gender and ethnicity, AMI (OR = 1.05, Analysis Two: Associations Between Value 95% CI = [1.01, 1.08]) and AVS-R (OR = 0.08, 95% CI: Endorsement and Attitudes to Mental Health and [0.01, 0.98]) predicted the likelihood that students perceived Help-Seeking a need for mental health treatment. Specifically, for each unit increase in positive attitudes toward mental health, students Next, we used three sets of hierarchical linear regressions to were 5% more likely to perceive needing mental health treat- examine the AVS-R, LVS, and the two shared factors derived ment (β = 0.04, p = 0.01). In contrast, for each unit increase in in the previous set of analyses, as predictors of students’ atti- adherence to Asian values, students were 92% less likely to tudes to mental health. A first set of hierarchical linear regres- perceive a need for mental health treatment (β = −2.59, p < sions examined the AVS-R as a predictor of attitudes towards 0.05). No significant predictors emerged with help-seeking mental health. A second set of hierarchical linear regressions behavior as the outcome variable (p > 0.27). examined the LVS as a predictor of attitudes towards mental The second set of logistic regressions examined whether health. These analyses revealed that both the AVS-R and the students’ mental health attitudes (assessed via the AMI) and LVS added significantly to the prediction of students’ atti- their endorsement of Latinx values (assessed via the LVS) tudes to mental health (see supplementary materials). predicted the likelihood of their perceived treatment need A third set of hierarchical linear regressions examined the and help-seeking behavior. Results are shown in Table S7. two shared factors that emerged from our factor analysis (i.e., After controlling for gender and ethnicity, a main effect of IO, CO) as predictors of students’ attitudes towards mental AMI emerged in predicting the likelihood of perceived treat- health. Using attitudes to mental health as the dependent var- ment need (OR = 1.06, 95% CI = [1.02, 1.09]), whereby for iable in two separate stepwise regressions, we entered ethnic- each unit increase in positive attitudes towards mental health, ity and gender in an initial step, either the IO factor or the CO students were 6% more likely to perceive a need for treatment factor in a second step, and factor × demographic interaction (β = 0.05, p < 0.01). No significant predictors emerged with terms in a third step. help-seeking behavior as the outcome variable (p > 0.26). In the analysis focusing on the IO factor, ethnicity and The third set of logistic regressions examined whether our gender were significantly associated with attitudes towards two factors, IO and CO, predicted students’ perceived treat- mental health, R2 = 0.12, F(2,156) = 10.91, p < 0.001. The ment need and their help-seeking behavior. Ethnicity and gen- IO factor significantly added to the prediction of attitudes der were entered in step 1, AMI was entered in step 2, IO and towards mental health, ΔR2 = 0.07, F(1,155) = 13.02 , p < CO were entered in step 3, and factor × demographic interac- 0.001. IO was a significant inverse predictor of the AMI, after tions were entered in step 4. Results showed main effects of controlling for demographic variables. The step containing the AMI (OR = 1.05, 95% CI = [1.02, 1.09]) and our IO factor interaction term with the demographic variables did not add (OR = 0.10, 95% CI = [0.02, 0.55]) on the likelihood of significantly to the prediction of AMI (see Table S4). perceived treatment need. For each unit increase in positive In the analysis focusing on the CO factor, ethnicity and attitudes to mental health, students were 5% more likely to gender were significantly associated with attitudes towards perceive a need for treatment (β = 0.05, p < 0.01). mental health, R2 = 0.12, F(2,156) = 10.91, p < 0.001. The Conversely, for each unit increase in IO, students were 90% CO factor did not add significantly to the prediction of atti- less likely to perceive a need for treatment (β = −2.30, p < tudes towards mental health. Similarly, the interaction term 0.01). With help-seeking behavior as the outcome variable, with ethnicity and gender did not add significantly to the pre- only the interaction between IO and gender was significant diction of attitudes towards mental health (see Table S5). (OR = 0.00, 95% CI = [0.00, 0.74]) (Table 2). Because the main effect of IO was not significant and the sample size Analysis Three: Associations Between Cultural Value reporting on help-seeking was small, we did not probe this Endorsement and Perceived Treatment Need and interaction further. Help-Seeking Our final analysis looking at the CO factor revealed only a main effect of AMI (OR = 1.07, 95% CI = [1.03, 1.10]) on the Three sets of hierarchical logistic regressions were conducted likelihood of perceived treatment need. For each unit increase to examine whether students’ attitudes towards mental health in positive attitudes to mental health, students were 7% more
J. Racial and Ethnic Health Disparities Table 2 Logistic regressions with interdependent orientation predicting perceived need and help-seeking behavior Outcome Perceived need Help-seeking Predictor OR SE 95% CI p OR SE 95% CI p LL UL LL UL Step 1 Ethnicitya 0.48 0.50 0.18 1.28 0.14 49.05 2.36 0.48 5046.28 0.10 Genderb 0.70 0.54 0.24 2.01 0.51 0.01 2.51 0.00 1.62 0.08 Step 2 AMI 1.05 0.02 1.02 1.09
J. Racial and Ethnic Health Disparities that the IO factor highlights the in-group and family unit, it is Limitations and Future Directions possible that these values are more salient and more directly relevant to mental health behaviors than broader cultural goals Our findings should be interpreted with several limitations in in college students (extended discussion of the factor analysis mind. First, the ethnic demographic makeup of our university and cultural values scales alone is available in the supplemen- (33.8% Asian, 41.5% Latinx) is not representative of the larg- tary text). er US population (5.9% Asian, 18.5% Latinx)  and thus our findings may not be reflective of broader Asian and Latinx experiences—that is, those participating in our study are Shared Cultural Values, Perceived Need, and Help- surrounded by more diverse cultural feedback than the aver- Seeking age Asian or Latinx youth might be. Moreover, it is important to note that both ethnic groups are heterogeneous, and thus In the current study, we observed that students who students may have varied more in their experiences and ad- scored highly on our IO factor were less likely to endorse herence to broad Asian or Latinx values specifically, which needing mental health treatment, over and above ethnicity adds to our efforts to look broadly at shared themes rather than and their mental health attitudes. In interpreting this find- values specific to any one group. Second, college environ- ing, it is important to consider research showing that fam- ments have uniquely accessible on-campus counseling centers ilism and group-orientation, two subcomponents of IO, with flexible service delivery and payment options, staffed by can act as protective factors for mental health . In mental health professionals with specialized training to work particular, group-oriented attitudes, such as a greater with college youth and motivated to reach students. Thus, the sense of pride and belonging to one’s ethnic group, have mental health environment of college campuses does not ac- been linked to a decreased likelihood of psychiatric ser- curately capture off-campus mental health experiences or oth- vice use in Latinx adults and decreased odds of lifetime er types of mental health help that Asian and Latinx youth psychiatric diagnoses for both Asian and Latinx adults receive. Third, given that only those students who indicated [62, 63]. It is possible that students in our sample with mental health treatment need reported on help-seeking behav- higher IO experience the benefits of familism and in- iors, we were underpowered in predicting help-seeking group orientation in having a greater support network behaviors—only 33 participants responded to this question. and may thus be in lesser need of mental health services. It is possible that students were reluctant to self-report on However, in light of our finding that greater IO also pre- needing and seeking treatment, even though their answers dicted negative mental health attitudes, an alternative in- were anonymized. Including implicit measures of emotional terpretation is that IO might encourage underreported or health to complement self-report may further our understand- under-perceived need for help, on which critically impor- ing of the broader sociocultural contexts in which youth de- tant help-seeking behavior is contingent. This association velop . Lastly, this was a cross-sectional study; a longitu- was not observed with our CO factor. An important di- dinal design examining the interplay between interdependent rection for future research will be to explicitly arbitrate cultural value endorsement, mental health attitudes, and help- between these possibilities. Our initial data from a fairly seeking behavior over time would provide insights into the large and diverse college sample indicate that probing direction of effects of these variables. underlying shared cultural values, irrespective of ethnici- Given the nuanced role that interdependent cultural values ty, may be informative for university mental health ser- play in emotional well-being, it will be important to examine vice providers. We therefore contend that probing cultural circumstances under which these group-oriented values may values when assessing students’ mental health needs is be beneficial or detrimental to mental health attitudes and more in line with students’ lived experiences than relying behaviors. Under a cultural value-based approach, values that on ethnic background alone. may otherwise seem irrelevant may actually hold Notably, IO inversely predicted perceived need, whereas significance—that is, it is important to strike a balance be- the LVS alone did not, even though the IO factor was largely tween understanding how individuals uniquely perceive their comprised of LVS items. We note that neither the retained cultures and also considering intersectionality and inter-group AVS-R or LVS items separately were predictive of any out- similarities. For instance, research might probe whether great- comes of interest. As such, the IO factor contributed beyond er adherence to Interdependent Orientation predicts negative the role of AVS and LVS examined separately and may thus mental health attitudes and mental health behaviors in other be more relevant for predicting mental health behaviors in our ethnic groups as well. Additionally, though the current work sample. Our data indicate that probing underlying values that identified similarities in internal barriers to help-seeking be- have been typically associated with specific ethnic groups haviors across groups, we are in no way stating that structural outside of the bounds of ethnicity and culture may be infor- barriers, such as diminished access to resources, or cost, are mative for university mental health service providers. irrelevant to mental health behaviors in ethnic minority youth.
J. Racial and Ethnic Health Disparities We would also like to caution against an automatic preference Declarations for considering professional psychological services as the ide- al method of support for mental health. Nonetheless, behav- Ethics Approval This study was approved by the University of California Institutional Review Board (IRB). ioral health services are the main source of mental health sup- port offered by colleges and universities. As such, it is impor- Informed Consent Informed consent was obtained from all individual tant to better understand why some students might not be participants included in the study. engaging with these available services. If specific cultural values are leading students to underutilize campus mental Conflict of Interest The authors declare no competing interests. health resources but perhaps engage in other types of help- seeking, then it is important to identify what alternative methods of support might look like. 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